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Staying Active With RA: Esther's Story

People with rheumatoid arthritis are sometimes advised to avoid high-intensity exercise. But don't tell Esther Wei, who runs marathons without injuring her joints.

Anyone who believes people with rheumatoid arthritis (RA) can’t be athletic should try to keep up with Esther Wei. She started running at age 42, about 10 years after being diagnosed with RA, and has since completed 12 marathons.

A nurse practitioner and certified diabetes educator at New York-Presbyterian Hospital in New York City, Wei was diagnosed with RA in her early thirties. Her previous exercises of choice were aerobics and rollerblading, but that changed when she took a trip to San Francisco and didn’t want to bring her rollerblades. She joined one of her friends for a run instead.

That trip was in June, and in November she ran her first 5K. A year later, she ran her first New York City marathon. Now she puts many more miles on her running shoes than on her rollerblades.

“I’m really fortunate that I have been able to keep up with my running,” Wei says. Part of her success has been the way she approaches running with RA. She listens to her body and slows down her training for pain management when her joints act up.

Lately, her knees have been bothering her. “I’m starting to wonder if I’ll need to cut back on distance and do half marathons,” she says. “You have to do what you can do.” But she vows to not let it stop her from running.

How to Exercise With RA

Typically, doctors recommend that people with RA be in remission before returning to the activity level before being diagnosed, says Nathan Wei, MD, a clinical researcher and director of the Arthritis Treatment Center in Frederick, Md., and also Esther Wei’s brother.

Wei’s treatment keeps her symptoms under control, but she still has occasional flare-ups that require adjusting her medication regimen. Over the years, some flare-ups have stopped her training. She tries to run the New York City marathon every year, but she's missed a few because of RA flare-ups.

However, Dr. Wei says that someone who wasn’t used to being physically active before being diagnosed with RA should avoid high-impact activities and first try exercises that are gentler on the joints, such as cycling, swimming, and using an elliptical machine at the gym.

Research has found that people with RA can exercise and reap its benefits — such as better cardiovascular fitness, increased muscle strength, and weight loss — without causing joint damage, even when they’re doing higher-intensity exercises. Exercise may be even more important because studies have also found that people with RA can lose up to 70 percent of their strength due to the condition. Finding the right mix of intensity and pain management for relief from RA is key.

Tips for Running With RA

What works for Wei might work for you, too. Her tips for marathon training and Dr. Wei’s suggestions for preventing injury include:

Wear the right shoes. Wei has found that very cushioned shoes work best for her. And because her feet have widened due to RA, she now wears men’s running shoes.

Avoid pushing yourself too hard. When Wei doesn’t feel well, she doesn’t run. “If I wake up and feel achy, I don’t run,” she says. The same goes for when she’s already out running. If she’s not comfortable going a certain distance, she cuts her run short.

Warm up and cool down. Dr. Wei says that it’s important to take time at the beginning of a workout to warm up rather than increasing intensity too quickly. In addition, he recommends taking time to cool down by spending the last several minutes going at a lower intensity before ending your workout.

Exercise when you feel your best. Although afternoon fatigue isn’t so bad for Wei, she knows that if she doesn’t run in the morning, she’ll lose motivation later in the day. She also runs with a friend for extra motivation.

Wake up early. Morning stiffness is one of the most common symptoms of RA. Wei wakes up early enough to have time to move around and work out any stiffness in her joints before heading out the door.

Cross-train to prevent injury. Wei also does yoga and strength training. She missed last year’s marathon in New York because of a frozen shoulder, and she’s working to recover withmore shoulder-strengthening exercises. Dr. Wei also recommends incorporating cardio, strength training, and stretching into your workout.

Stretch at the end of a workout. Wei knows that stretching after a run is important and takes time to do typical stretches for runners, such as quad and hamstring stretches. And Dr. Wei says that people with RA probably need more stretching than people who don’t have the disease because arthritis makes them more prone to injury. If a particular joint is bothering you after warming up, exercising, cooling down, and stretching, he recommends icing it right away. Then, after 24 hours, apply moist heat, such as a warm compress, to prevent an injury.